Navigating Maternal and HIV Healthcare: Availability, Accessibility, and Lived Experiences of Women With Disabilities in Uganda
Simon Peter Asiimwe, Jacqueline Kyeyune, Francis Ocitti, Jolly Twinomuyambi, Ritah Nakijoba, Patience Nantume, Aida N. Kawuma, Paul Mubiri, Johnson Magoola, Robin Percy Mugundho, William Baluku, Betty Kwagala, Francis W. Ojara, Catriona WaittBackground
Women with disabilities (WWD) face significant challenges accessing maternal and HIV healthcare services. However, evidence on service availability, accessibility, and the lived experiences of women with disabilities during pregnancy and breastfeeding remains limited in Uganda.
Methods
We used a descriptive, exploratory qualitative design. The descriptive component assessed the availability and accessibility of HIV and maternal healthcare services in the Central Region (Kampala and Wakiso districts) and Northern Region (Lango and Acholi sub-regions). We conducted in-depth interviews with 280 women with disabilities between April and June 2025. We analyzed the data thematically using NVivo version 15, guided by individual, provider-related, structural, and societal determinants of healthcare access.
Results
Across six healthcare facilities, disability accessibility was generally low. Wheelchairs were available in 50% (3/6) of facilities, accessible triage in 66.7% (4/6), and accessible toilets in none (0/6). Height-adjustable examination beds and other disability-inclusive resources were limited and available only in selected service areas. Overall, accessibility scores were below 50% across all facilities and service stations. Physical disability was the most common disability type across regions. Education and employment levels varied by region, with higher levels in Kampala. Five themes were identified: (1) Experiences navigating maternal and HIV healthcare services, including respectful care. (2) Disability-inclusive health systems, including inaccessible infrastructure, inadequate assistive devices, and poor disability documentation; (3) Social and personal factors shaping healthcare-seeking behaviour, including personal and socioeconomic barriers, mobility challenges, and gender-based violence; (4) Enablers for equitable healthcare access included supportive healthcare providers and free services. (5) Recommendations for disability-inclusive healthcare services included improving physical accessibility of healthcare facilities, strengthening healthcare worker training, providing communication support such as sign language interpretation, improving disability documentation, increasing disability representation, and community sensitization.
Conclusion
Women with disabilities in Uganda face barriers to equitable maternal and HIV healthcare access. Strengthening disability-inclusive policies, improving accessibility, enhancing health worker capacity, and involving women with disabilities in decision-making are essential to advancing equitable, people-centred healthcare.